Form Lb-0910 - Application For Client Number - Tennessee Department Of Labor And Workforce Development Page 2
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2Client’s Federal Number
___ ___ - ___ ___ ___ ___ ___ ___ ___
11. A. Describe the major business activity of the account to be covered, listing any products manufactured or sold, or service provided.
Be as descriptive as possible. _____________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
B. In what Tennessee County is your company located? ____________________________________________________________
(If account covers sales reps or other personnel working from home, list county or city of residence.)
C. Is the primary purpose of the employee(s) covered by this application to support other locations of your company?
YES
NO
If YES, then check the category that best applies. Add comments as necessary.
HEADQUARTERS (e.g., corporate or regional management offices) _________________________________________________
ADMINISTRATIVE (e.g., bookkeeping, accounting, payroll, HR, PR) ________________________________________________
WAREHOUSING (e.g., storage, distribution, equipment yard)_____________________________________________________
SALESMAN (indicate product) ____________________________________________________________________________
INFO TECH (e.g., software publication, programming, systems design, data processing) ______________________________
OTHER (e.g., repair shop, security office, maintenance, employee recreation facility) ____________________________________
D. Below are some industries that often need additional clarification. This section may not apply to every employer.
If you see your industry, please answer the corresponding question(s).
Construction:
What type of construction? _________________________________________________________________
Mostly residential or non-residential?
residential
non-residential
Property Mgmt.:
Does this business manage property for others or for itself?
others
itself
Mostly residential or non-residential?
residential
non-residential
Trucking:
Is the main trucking activity local or long distance?
local
long distance
Mostly truckload or less than truckload?
truckload
less than truckload
Employment Agency: Is this a temporary staffing service or an employment placement agency?
Temporary Staffing Service
Employment Placement Agency
Health Care:
Is this a
doctor’s office,
multi-disciplinary clinic,
freestanding urgent care center or
other?
Please specify.________________________________________________________________________
Info Tech (IT):
Which category best fits your business?
software publication
programming
systems design
data processing
Restaurant:
Is the restaurant
full service,
fast food,
cafeteria/buffet,
snack bar,
other?
Please specify. __________________________________________________________________________
Consulting:
What is the primary type of consulting?
administrative,
human resources,
marketing,
process/logistics,
environmental, or
other
Please specify. __________________________________________________________________________
Home Health:
Does the care involve skilled nursing?
YES
NO
Retail:
What is the primary product? _______________________________________________________________
Wholesale:
What is the primary product? _______________________________________________________________
Mining:
What is the primary product? _______________________________________________________________
Convenience Store:
Does the store sell gasoline?
YES
NO
Manufacturing:
What is the primary product? _______________________________________________________________
Page 2
LB-0910 (Rev. 02-15)
RDA 1559
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